While giving her own team of therapists high marks for patient care, Kathy Russell also credits the whole team at Pine Run, Doylestown, Pennsylvania, with the success of the facility's rehabilitation program. “It's hard to have your best rehab outcome if the rest of the team isn't working well,” says the rehab program coordinator. She singles out the nursing staff for special recognition. “For example, if a patient is scheduled for rehab at 10 o'clock, the nurses make sure the patient has his or her pain meds by 9:30. The session becomes that much more effective because nursing care has been integrated.”
Pine Run is a continuing care retirement community with 298 independent apartments and 127 skilled beds, 50 of which are short-term rehab. The rehabilitation department is located in the 70-bed skilled healthcare center, which also includes a licensed Personal Care floor to support people with dementia. Pine Run contracts with Aegis Therapies for its rehabilitation programming and staffing. Russell oversees five full-time physical therapists, four full-time occupational therapists, a speech therapist, and “about a dozen” PRN staff who rotate as the caseload fluctuates and to cover weekends. Russell is a licensed physical therapist and has been in rehab since 1979. She has been the program coordinator at Pine Run's rehab facility for about a year-and-a-half.
“This is a subacute-type facility,” Russell says. “The majority of people coming into our health center are here for short-term rehab stays. We commonly see patients post orthopedic surgery, after acute neurological conditions, and complex medical issues,” Russell explains. She says Pine Run's rehabilitation program success is attributed to an integrated approach. The facility offers a lot of additional support not seen in many skilled nursing facilities. “We're a little atypical that way,” she says. “Quality of care is very uniform from department to department. We have a strong nursing staff, a strong rehab team, and a lot of good support from specialists like a nurse practitioner, wound care nurse, and a physiatrist. The facility has two physiatrists who come from Doylestown Hospital to consult.” The physiatrists, medical doctors with specialized training in physical medicine, rehabilitation, and pain management, see every patient admitted for rehab. Russell says any complications get managed quickly. If somebody is in pain or a medication isn't working, it is adjusted very quickly through a consultation with a physiatrist and attending physician.
Training is backbone
Russell attributes Aegis' training and equipment as keys to her staff's success. All therapists are trained in three Core Programs-Dementia Management, Complex Disease Management, and Falls and Balance. The Aegis Information Management System (AIMS) allows the therapist to enter a patient's demographics, RUG levels, and billing information. This allows Aegis and Pine Run to monitor service delivery and treatment outcomes. Aegis trains and certifies all therapists in ROM, the Rehab Outcome Measurement system. This functional outcome tool is used to measure patient rehab progress in the skilled nursing setting. This is unlike other tools, which are geared toward the acute hospital setting. Russell also says ROM can retrieve data by diagnosis and sort medically complex patients to see the effect of rehab. This is particularly useful in justifying treatment to insurance companies and in marketing to physicians and other referral sources.
Freedom through Functionality (FTF) is a strength training program using Nautilus® equipment specifically geared to the geriatric patient. The five machines were selected to support posture and the muscles that help the patient stand, walk, and hold the body upright. Weight increments are much lighter than regular gym equipment. The pieces are also designed for easier transfer from wheelchairs.
Aegis trains all of its therapists in the Restore, Compensate, and Adapt (RCA) model of care. Upon evaluation, the therapist identifies deficits that are barriers to discharge. The goal is to maximize independence. If indicated, a therapist goes to the home before the patient is discharged to make sure the patient can function safely in the home environment. The therapist will make recommendations for any adaptations necessary. “We're very focused on getting good outcomes and getting people home as quickly as possible.” Family training is also extremely important for a smooth discharge.
Future of rehab services
Russell predicts shorter length of stay, getting patients back in the home as soon as possible, more efficient delivery service models, and evidence-based outcomes as the future of skilled nursing facility rehab. “As you look to the future, one can't imagine the government just spending more and more and more without provable outcomes,” Russell says. “I also see good restorative nursing programs growing in importance.”